Provider Demographics
NPI:1245990407
Name:SANDERS, CLARENCE (CASAC)
Entity type:Individual
Prefix:
First Name:CLARENCE
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BATTLE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-1520
Mailing Address - Country:US
Mailing Address - Phone:646-924-5985
Mailing Address - Fax:
Practice Address - Street 1:79 ALEXANDER AVE STE 32A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-4475
Practice Address - Country:US
Practice Address - Phone:646-924-5985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19041101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)